Assessing the Chart Versus Assessing the Patient

This week I had a nursing student share one of her clinical experiences with me and I wanted to share it with all of you. She had a 70 year old female patient admitted with pneumonia. After prepping for her patient and reading her chart she noted that many of the nurses had reported altered mental status and that the client had to be fed her meals by a nurse. After completing her morning shift assessment the student nurse reported the patient to be alert and oriented x 3 with her spouse sitting at the bedside. When she took the client's breakfast tray in, the student nurse asked the client if she would need assistance with her meal. The client reported she was fine and wondered why the nurses continued to try and feed her. After further assessment the student reported that after eating about 50% of her meal the patient became nauseated and did not want to continue to eat. When the student reported these findings to the primary nurse, the nurse informed the student that the patient needed to be fed due to her altered mental status. The student questioned the nurse regarding the prn medication of zofran and asked if she could give this to the patient. The nurse said she would give it, but she was too busy at the time, and 30 minutes later she still had not given the med.

It is obvious to me that the nurse was choosing to assess the patient chart rather than the patient. The clinical instructor was informed of the situation and the client did receive her medication, however I feel that if the student had not been with this particular patient that day this would have played out much differently.

Week #15 FINAL

The Count Down is ON! I can not wait until May 5th! After my final physical exam in Advanced Assessment, I will be completely finished with this semester. This was the heaviest load I have ever taken in my entire academic career; 17 hours (10 undergrad and 7 grad) and now my BSN is complete! The next date to look forward to, May 15th GRADUATION!

I was really looking forward to taking the ENTIRE summer off...but as it happens now I will be taking 6 hours of graduate courses to lighten by load Fall semester when I start FNP. This summer I am sure I will wonder why I decided to do this, but in the Fall I will be so glad I did.

Good luck to all of you and I wish you all much success in your nursing careers!

December 2011 here we come : )

Week #14 Change Paper Complete

With the semester coming to an end, I am finding many myself focused on completing my big projects. I am excited to say, my change project and paper is complete! I enjoyed working towards a successful change and have found that with the change of the dosage and calculations modules students are developing a better understanding of the material. I am pleased to say the pass rate of the first clinical math exam did increase from Fall 2009 to Spring 2010 semesters. Students have completed their evaluations, the reviews look great and with a few "tweaks", next semester should be even more successful.

Week #13 LVN/VN Educators

To comment on the post Dr. Anderson made concerning LVN instructors. I currently work in an ADN program and the majority of my work consists of helping students in the lab with assessment and skills. It just so happens our rooms and my office is located in the middle of the LVN education department. Prior to taking the position in the ADN dept. I had looked into the LVN department, however at the time because I did not have my BSN as odd as this sounds I did not qualify for a position with their dept. After working in this area over the past year, I have noticed a big difference in the attitudes of the LVN vs ADN students. For example, the first semester ADN students seem to "gripe" about more and expect to be "spoon fed" by the faculty; however the LVN students seem to work together and focus on learning the material and skills given to them. Before check-off's or exams I notice the LVN students focused on studying the material. The ADN students are more focused on wanting to study only the material in which they will be tested. Basically they want to memorize what you are going to test them on, regurgitate it and forget it. I am sure we have all been guilty of this before, however this is material they need to be retaining long term.

I also have the opportunity to sit in on the APA committee and review the students grades and letters of appeal who seek re-admittance into the ADN program after failure of a semester. I have found that many of the instructors are quick to deny their re-admittance to the ADN program and refer them to the LVN program. Is this really fair to the LVN program....It is saying "your not good enough for us, so we will send you to the LVN's". Personally I can see it both ways, however there is ALOT of animosity between the LVN and ADN department and I have not figured this out.

Week #12 Illuminate

This week my preceptor introduced me to illuminate. This is a method of communication for students and instructors taking online courses. In getting started each member needs a headset with ear pieces and a microphone. Once the instructor and the student are logged onto the website, the communication can begin. If the computers have a camera available you can turn the camera on and see each person the the circle of communication. This way the instructor could have one on one sessions or sessions with the entire class at once. The school also has a white board available which allows the instructor to draw and write and make available to the students just as they are sitting in class.
I am sure all my terminology is completely wrong with explaining this procedure! I am not very computer savvy. After seeing and learning this new way of communication, I was very impressed! So much more to learn.

Week #11 Professional Interview

This past week I had the opportunity to interview my preceptor. The interview went well and I enjoyed learning more about her. I have had the opportunity to work with my preceptor as a co-worker for the past year and feel that she is a great mentor. She is currently an RN, MSN, FNP-C practicing as an instructor at an associate degree nursing program. Her primary goal is to function as a strong student advocate and also serves on the curriculum committee. I enjoy learning from her and look forward to learning more as we come to a conclusion on my change project.